Bruelle P, Ferrer J M, Macheboeuf M, Roert C, Viel E, Eledjam J J
Département d'Anesthésie-Réanimation, Centre Hospitalier Universitaire, Nîmes.
Cah Anesthesiol. 1991;39(2):97-103.
Epidural and spinal administration of opioids in obstetrics can be used during labour and for cesarean section. Although these routes of administration are of limited use when opiates are employed as sole agents, the association with local anesthetics may improve the characteristics of analgesia. The administration of a local anesthetic-opiate mixture allows a reduction of the total amount of local anesthetics, thus reducing the incidence of maternal hypotension and the percentage of instrumental extraction. In the particular setting of cesarean section, opioids could shorten the onset and improve the quality of the duration of analgesia. Opioids may also be used for postoperative analgesia after cesarean section. Since they could be responsible for an opioid-related respiratory depression in the mother and the neonate, a strict supervision is absolutely necessary following this particular mode of administration of opiates. If human and technical means of supervision failed to bring into operation, it would be better not to use opioids by the spinal route in such a context.
阿片类药物在产科的硬膜外和脊髓给药可用于分娩期间及剖宫产手术。尽管在单独使用阿片类药物时这些给药途径的用途有限，但与局部麻醉药联合使用可能会改善镇痛效果。局部麻醉药与阿片类药物混合使用可减少局部麻醉药的总量，从而降低产妇低血压的发生率和器械助产的比例。在剖宫产的特定情况下，阿片类药物可缩短镇痛起效时间并改善镇痛持续时间的质量。阿片类药物也可用于剖宫产术后镇痛。由于它们可能导致母亲和新生儿出现与阿片类药物相关的呼吸抑制，因此在采用这种特定的阿片类药物给药方式后，严格的监测绝对必要。如果人力和技术监测手段无法实施，在这种情况下最好不要通过脊髓途径使用阿片类药物。
